A BILL TO BE ENTITLED
AN ACT to extend the first commitment pilot program, to further clarify LME core functions, and to allow additional time for an LME to merge when it has gone below the two hundred thousand population or six county threshold due to a change in county membership as recommended by the joint legislative oversight committee on mental health, developmental disabilities, and substance abuse services.
The General Assembly of North Carolina enacts:
SECTION 1.(a)  S.L. 2003‑178, as amended by S.L. 2006‑66, Section 10.27, reads as rewritten:
"SECTION 1.  The Secretary of Health and Human Services may, upon request of  an LME, waive temporarily the requirements of G.S. 122C‑261 through G.S. 122C‑263 and G.S. 122C‑281 through G.S. 122C‑283 pertaining to initial (first‑level) examinations by a physician or eligible psychologist of individuals meeting the criteria of G.S. 122C‑261(a) or G.S. 122C‑281(a), as applicable, as follows:
(1)	The Secretary has received a request from an LME to substitute for a physician or eligible psychologist, a licensed clinical social worker, a masters level psychiatric nurse, or a masters level certified clinical addictions specialist to conduct the initial (first‑level) examinations of individuals meeting the criteria of G.S. 122C‑261(a) or G.S. 122C‑281(a). The waiver shall be implemented on a pilot‑program basis. The request from the LME shall specifically describe:
a.	How the purpose of the statutory requirement would be better served by waiving the requirement and substituting the proposed change under the waiver.
b.	How the waiver will enable the LME to improve the delivery or management of mental health, developmental disabilities, and substance abuse services.
c.	How the services to be provided by the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist under the waiver are within each of these professional's scope of practice.
d.	How the health, safety, and welfare of individuals will continue to be at least as well protected under the waiver as under the statutory requirement.
(2)	The Secretary shall review the request and may approve it upon finding that:
a.	The request meets the requirements of this section.
b.	The request furthers the purposes of State policy under G.S. 122C‑2 and mental health, developmental disabilities, and substance abuse services reform.
c.	The request improves the delivery of mental health, developmental disabilities, and substance abuse services in the counties affected by the waiver and also protects the health, safety, and welfare of individuals receiving these services.
d.	The duties and responsibilities performed by the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist are within the individual's scope of practice.
(3)	The Secretary shall evaluate the effectiveness, quality, and efficiency of mental health, developmental disabilities, and substance abuse services and protection of health, safety, and welfare under the waiver. The Secretary shall send a report on the evaluation to the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substances Abuse Services  by October 1, 2009. The report shall include data gathered from all participating LMEs since the beginning of the pilot.
(4)	The waiver granted by the Secretary under this section shall be in effect until October 1,  2010.
(5)	The Secretary may grant a waiver under this section to up to 10 LMEs.
(6)	In no event shall the substitution of a licensed clinical social worker, masters level psychiatric nurse, or masters level certified clinical addictions specialist under a waiver granted under this section be construed as authorization to expand the scope of practice of the licensed clinical social worker, the masters level psychiatric nurse, or the masters level certified clinical addictions specialist.
(7)	The Department shall assure that staff performing the duties are trained and privileged to perform the functions identified in the waiver. The Department shall involve stakeholders including, but not limited to, the North Carolina Psychiatric Association, The North Carolina Nurses Association, National Association of Social Workers, The North Carolina Substance Abuse Professional Certification Board, North Carolina Psychological Association, The North Carolina Society for Clinical Social Work, and the North Carolina Medical Society in developing required staff competencies.
(8)	The LME shall assure that a physician is available at all times to provide backup support to include telephone consultation and face‑to‑face evaluation, if necessary.
SECTION 2.  This act becomes effective July 1, 2003, and expires October 1,  2010."
SECTION 1.(b)  The Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services (LOC) shall review the report submitted by the Secretary under S.L. 2003‑178, as amended by S.L. 2006‑66, Section 10.27 and Section 1.(b) of this act.  The LOC shall make recommendations to the 2011 General Assembly regarding whether to further extend the pilot or make it permanent and statewide.
SECTION 2.  G.S. 122C‑115.4 reads as rewritten:
"§ 122C‑115.4.  Functions of local management entities.
(a)	Local management entities are responsible for the management and oversight of the public system of mental health, developmental disabilities, and substance abuse services at the community level. An LME shall plan, develop, implement, and monitor services within a specified geographic area to ensure expected outcomes for consumers within available resources.
(b)	The primary functions of an LME are designated in this subsection and shall not be conducted by any other entity unless an LME voluntarily enters into a contract with that entity under subsection (c) of this section. The primary functions include all of the following:
(1)	Access for all citizens to the core services described in G.S. 122C‑2. In particular, this shall include the implementation of a 24‑hour a day, seven‑day a week screening, triage, and referral process and a uniform portal of entry into care.
(2)	Provider endorsement, monitoring, technical assistance, capacity development, and quality control. An LME may remove a provider's endorsement if a provider fails to meet defined quality criteria or fails to provide required data to the LME.
(3)	Utilization management, utilization review, and determination of the appropriate level and intensity of services including the review and approval of the person centered plans for consumers who receive State‑funded services. Concurrent review of person centered plans for all consumers in the LME's catchment area who receive Medicaid funded services.
(4)	Authorization of the utilization of State psychiatric hospitals and other State facilities. Authorization of eligibility determination requests for recipients under a CAP‑MR/DD waiver.
(5)	Care coordination and quality management. This function includes the direct monitoring of the effectiveness of person centered plans. It also includes the initiation of and participation in the development of required modifications to the plans for high risk and high cost consumers in order to achieve better client outcomes or equivalent outcomes in a more cost‑effective manner. Monitoring effectiveness includes reviewing client outcomes data supplied by the provider, direct contact with consumers, and review of consumer charts.
(6)	Community collaboration and consumer affairs including a process to protect consumer rights, an appeals process, and support of an effective consumer and family advisory committee.
(7)	Financial management and accountability for the use of State and local funds and information management for the delivery of publicly funded services.
(c)	Subject to subsection (b) of this section and all applicable State and federal laws and rules established by the Secretary, an LME may contract with a public or private entity for the implementation of LME functions designated under subsection (b) of this section. Nothing in this subsection shall be construed to supercede the authority of an LME to be the sole entity with the authority to implement the functions designated in subsection (b) of this section.
(d)	Except as provided in G.S. 122C‑142.1 and G.S. 122C‑125, the Secretary may not remove from an LME or designate another entity as also eligible to implement any function enumerated under subsection (b) of this section unless all of the following applies:
(1)	The LME fails during the previous three months to achieve a satisfactory outcome on any of the critical performance measures developed by the Secretary under G.S. 122C‑112.1(33).
(2)	The Secretary provides focused technical assistance to the LME in the implementation of the function. The assistance shall continue for at least six months or until the LME achieves a satisfactory outcome on the performance measure, whichever occurs first.
(3)	If, after six months of receiving technical assistance from the Secretary, the LME still fails to achieve or maintain a satisfactory outcome on the critical performance measure, the Secretary shall enter into a contract with another LME or agency to implement the function on behalf of the LME from which the function has been removed.
(e)	Notwithstanding subsection (d) of this section, in the case of serious financial mismanagement or serious regulatory noncompliance, the Secretary may temporarily remove an LME function after consultation with the Joint Legislative Oversight Committee on Mental Health, Developmental Disabilities, and Substance Abuse Services.
(f)	The Commission shall adopt rules regarding the following matters:
(1)	The definition of a high risk consumer. Until such time as the Commission adopts a rule under this subdivision, a high risk consumer means a person who has been assessed as needing emergent crisis services three or more times in the previous 12 months.
(2)	The definition of a high cost consumer. Until such time as the Commission adopts a rule under this subdivision, a high cost consumer means a person whose treatment plan is expected to incur costs in the top twenty percent (20%) of expenditures for all consumers in a disability group.
(3)	The notice and procedural requirements for removing one or more LME functions under subsection (d) of this section."
SECTION 3.  G.S. 122C‑115(a1) reads as rewritten:
"(a1)	Effective July 1, 2007, the Department of Health and Human Services shall reduce by ten percent (10%) annually the administrative funding for LMEs that do not comply with the catchment area requirements ofsubsection (a) of this section. However, an LME that does not comply with the catchment area requirements because of a change in county membership shall have 12 months from the effective date of the change to comply with subsection (a) of this section."
SECTION 4.  This act is effective when it becomes law.